You Are Now Eligible For Medicare Now What? Part # 1
You Are Now Eligible For Medicare Now What? Part # 1What is a Medicare
Who Medicare is for?
• People ages 65 and older
• People under age 65 with certain disabilities
• All people with end-stage renal (kidney) disease (ESRD)
• Your basic Medicare coverage
• Part A, which covers hospital costs, as well as skilled nursing facility and hospice care
Part B, which covers certain medical costs, like doctor visits.
Other Medicare Choices
• Parts C and D offered and administered by private health insurance companies.
• Part C is often referred to as Medicare Advantage. It combines Parts A and B, and usually Part D, in one plan.
Part D helps you with prescription drug cots. It’s add to either Original Medicare or a Medicare Supplement plan.
Medicare Doesn’t Cover Everything!!
• Medicare covers 80% of your medicare costs. A private insurance plan can help cover what Original Medicare doesn’t cover. Two kinds of private plans include:
• Medicare Advantage, also called Part C
• Medicare Supplement insurance, also called Medigap
No matter which type you choose, you are still in the Medicare program as long as you pay your Medicare premium.
No Limit To Out Of Pocket Costs!!!
You generally have to pay a portion of the costs for each service covered by Parts A and B. and if you need certain services that aren’t covered under Medicare Part A or Part B, you have to pay for those yourself, Plus, with Original Medicare there’s no yearly limit for what you pay out of pocket.
Medicare Advantage Plans
• A Medicare Advantage plan includes Parts A and B, and some plans include prescription drug coverage.
• With Medicare Advantage plans, there is costs sharing for:
• Copays-the flat fee you pay when you see the doctor
• Coinsurance- the percentage of the total bill you have to pay
• Deductibles- the amount you pay before your insurance starts to pay for covered services.
• Medicare Advantage plans have a yearly limit on your out-of-pocket spending on copays, coinsurance and deductibles.
With Medicare Advantage, you may be required to use doctors and hospitals in your plan’s network.
• Health maintenance organization (HMO)plan-
1-You’ll use doctors in the network
2-You might need a referral to see a specialist.
• Preferred provider organisation (PPO) plans- 1-You can use doctors and hospitals outside of the network, but often for a higher copay.
• Special Needs Plans (SNP’s)
• 1-You’ll use doctors in the network.
• 2-You might need a referral to see a specialist. 3-SNP’s must include prescription drug coverage.
HMO Point-Of-Service (HMO-POS) plans 1-You’ll use doctors inside the network 2- You may also go outside of the network, but often for a higher copay or coinsurance.
Advantage Plan – Additional Benefits
• Many Medicare Advantage plans also have prescription drug coverage. They may also include additional benefits, such as:
• Dental care
• Eye care
• Wellness services
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